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Hypoparathyroidism

Parathyroid-related hypocalcemia

Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).

Causes

There are 4 tiny parathyroid glands in the neck, located near or attached to the back side of the thyroid gland.

The parathyroid glands help regulate calcium absorption, use, and removal by the body. They do this by producing PTH. PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone. It is important for healthy bones.

Hypoparathyroidism occurs when the glands produce too little PTH. The blood calcium level falls, and the phosphorus level rises.

The most common cause of hypoparathyroidism is injury to the parathyroid glands during thyroid or neck surgery. It may also be caused by any of the following:

  • Autoimmune attack on the parathyroid glands (common)
  • Very low magnesium level in the blood (reversible)
  • Radioactive iodine treatment for hyperthyroidism (very rare)

DiGeorge syndrome is a disease in which hypoparathyroidism occurs because all the parathyroid glands are missing at birth. This disease includes other health problems besides hypoparathyroidism. It is usually diagnosed in childhood.

Familial hypoparathyroidism occurs with other endocrine diseases such as adrenal insufficiency in a syndrome called type I polyglandular autoimmune syndrome (PGA I).

Symptoms

Onset of the disease is very gradual and symptoms can be mild. Many people diagnosed with hypoparathyroidism have had symptoms for years before they are diagnosed. Symptoms may be so mild that the diagnosis is made after a screening blood test that shows low calcium.

Symptoms may include any of the following:

  • Tingling lips, fingers, and toes (most common)
  • Muscle cramps (most common)
  • Muscle spasms called tetany (can affect the larynx, causing breathing difficulties)
  • Abdominal pain
  • Abnormal heart rhythm
  • Brittle nails
  • Cataracts
  • Calcium deposits in some tissues 
  • Decreased consciousness
  • Dry hair
  • Dry, scaly skin
  • Pain in the face, legs, and feet
  • Painful menstruation
  • Seizures
  • Teeth that do not grow in on time, or at all
  • Weakened tooth enamel (in children)

Exams and Tests

Your health care provider will do a physical exam and ask about symptoms.

Tests that will be done include:

Other tests that may be ordered include:

Treatment

The goal of treatment is to reduce symptoms and restore the calcium and mineral balance in the body.

Treatment involves calcium carbonate and vitamin D supplements. These usually must be taken for life. Blood levels are measured regularly to make sure that the dose is correct. A high-calcium, low-phosphorous diet is recommended.

Injections of PTH may be recommended for some people. Your provider can tell you if this medicine is right for you.

People who have life-threatening attacks of low calcium levels or prolonged muscle contractions are given calcium through a vein (IV). Precautions are taken to prevent seizures or larynx spasms. Your heart is monitored for abnormal rhythms until you are stable. When the life-threatening attack has been controlled, treatment continues with medicine taken by mouth.

Outlook (Prognosis)

The outcome is likely to be good if the diagnosis is made early. But changes in the teeth, cataracts, and brain calcifications cannot be reversed in children who have undiagnosed hypoparathyroidism during development.

Possible Complications

Hypoparathyroidism in children may lead to poor growth, abnormal teeth, and slow mental development.

Too much treatment with vitamin D and calcium can cause high blood calcium (hypercalcemia) or high urine calcium (hypercalciuria). Excess treatment may sometimes interfere with kidney function, or even cause kidney failure.

Hypoparathyroidism increases the risk for:

When to Contact a Medical Professional

Contact your provider if you develop any symptoms of hypoparathyroidism.

Seizures or breathing problems are an emergency. Call 911 or the local emergency number right away.

Open References

References

Husebye E, Weetman AP. Autoimmune polyglandular syndromes. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 132.

Reid LM, Kamani D, Randolph GW. Management of parathyroid disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 123.

Thakker RV. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 227.

Text only

  • Endocrine glands

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Parathyroid glands

    The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.

    Parathyroid glands

    illustration

    • Endocrine glands

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Parathyroid glands

      The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.

      Parathyroid glands

      illustration

     

    Review Date: 5/20/2024

    Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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